---
type: source
title: "Trump Administration Announces Deals with Eli Lilly and Novo Nordisk to Slash GLP-1 Prices for Medicare"
author: "CNBC / Multiple sources"
url: https://www.cnbc.com/2025/11/06/trump-eli-lilly-novo-nordisk-deal-obesity-drug-prices.html
date: 2025-11-06
domain: health
secondary_domains: [internet-finance]
format: news
status: enrichment
priority: high
tags: [glp-1, drug-pricing, medicare, policy, trump-administration, market-structure]
processed_by: vida
processed_date: 2026-03-16
enrichments_applied: ["GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035.md", "glp-1-persistence-drops-to-15-percent-at-two-years-for-non-diabetic-obesity-patients-undermining-chronic-use-economics.md", "lower-income-patients-show-higher-glp-1-discontinuation-rates-suggesting-affordability-not-just-clinical-factors-drive-persistence.md"]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

On November 6, 2025, President Trump announced agreements with Eli Lilly and Novo Nordisk to dramatically reduce GLP-1 prices and expand Medicare coverage for obesity — the first time Medicare will cover GLP-1 medications specifically for obesity.

**Pricing details:**
- Medicare/Medicaid price for semaglutide and tirzepatide: $245/month
- General price through TrumpRx: $350/month (down from ~$1,350/month injectable)
- Oral Wegovy: $149-$299/month (launched January 2026)
- Medicare beneficiaries: $50/month out-of-pocket maximum for tirzepatide (Zepbound) starting April 2026
- Future oral GLP-1s: initial dose priced at $150/month on TrumpRx

**Eligibility criteria for Medicare coverage:**
- BMI ≥27 with prediabetes or cardiovascular disease history
- BMI >30 with heart failure, uncontrolled hypertension, or chronic kidney disease
- ~10% of Medicare beneficiaries expected to be eligible

**Timeline:**
- Medicare GLP-1 payment demonstration: July 2026
- BALANCE Model in Medicaid: May 2026
- BALANCE Model in Medicare Part D: January 2027

## Agent Notes
**Why this matters:** This is a policy earthquake. Medicare covering GLP-1s for obesity — previously explicitly excluded — fundamentally changes the addressable population and the economics. The $245/month Medicare price is ~82% below list price. Combined with the $50/month OOP cap, this removes most financial barriers for the eligible Medicare population.
**What surprised me:** The eligibility criteria are NARROW — requiring comorbidities, not just obesity. This is smart from a cost containment perspective (targeting highest-risk/highest-savings patients) but limits the population-level impact. The deal structure (manufacturer concessions in exchange for coverage) is a novel mechanism outside normal CMS rulemaking.
**What I expected but didn't find:** No details on how MA plans specifically will implement this. No analysis of how the deal interacts with existing MA formulary management and prior authorization practices. No clarity on whether the $245 price applies to MA plans or just traditional Medicare.
**KB connections:** Connects to the MA economics research from March 10 session. Under capitation, MA plans bearing full risk would see the $245/month cost offset by downstream savings — but only if adherence is sustained. The eligibility criteria (high-risk patients with comorbidities) are the population where savings are most likely.
**Extraction hints:** Potential claim about the deal structure as a novel policy mechanism — manufacturer price concessions in exchange for coverage expansion, bypassing traditional CMS rulemaking. Also: the narrow eligibility targeting high-risk patients may actually make this cost-effective under capitation even if system-level impact is inflationary.
**Context:** This is a politically-driven deal that may not survive administration changes. The legal authority for this arrangement has been questioned. But the pricing signals (oral at $149-$299, Medicare at $245) are reshaping competitive dynamics regardless.

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035]]
WHY ARCHIVED: The price reduction + coverage expansion + narrow eligibility criteria fundamentally change the economics analyzed in the existing claim — the "inflationary through 2035" conclusion assumed higher prices and broader population
EXTRACTION HINT: Focus on how narrow eligibility (comorbid patients only) changes the cost-effectiveness calculus vs. broad population coverage


## Key Facts
- Medicare GLP-1 payment demonstration begins July 2026
- BALANCE Model in Medicaid begins May 2026
- BALANCE Model in Medicare Part D begins January 2027
- Oral Wegovy launches January 2026 at $149-$299/month
- Medicare beneficiary out-of-pocket maximum for tirzepatide is $50/month starting April 2026
- Approximately 10% of Medicare beneficiaries expected to be eligible under comorbidity criteria
